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U Keller Canyon ❑ Ox Mountain ❑ Newby Island ; Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> Phone (925)458-9800 Phone(650) 726-1819 Phone(408)945-2800 Phone(209) 982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> Is NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR G`'�[K_ - C d y- <br /> p �,�c �, WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS „ <br /> CITY, STATE,ZIP _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> 7- r_L_,jE_A 0-GLOVES U GOGGLES ❑RESPIRATOR ❑ HARD HAT <br /> ❑TY VEK 0 OTHER <br /> CONTACT PERSON iEFF u✓ - <br /> W _I 0T , �� �,�,r,sr ,4s T,g vr�ES ��y SPE_CIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERAlbR S CERTIFICATION I hereby cartly that the above named material Is not a hazardous <br /> waste as daflned by 40 CFR Part 281 or lifie 22 of the California code ofregulagona,has been properly <br /> described classified and packaged and is in proper condition for transportation arcoming to applicable <br /> regulations ANI) If the waste Is a treeterent raaldtrs of a previously restricted hsardous waste <br /> canoto e withh ft requirements LaM � Restrictions <br /> rtof440 CFR Part x2666 warrant <br /> s no ni o Io gat e waste has been treated in RECEIVING FACILITY u, .q 4 <br /> 40 CFR Part 261 <br /> eager a hazardous waste as defined by <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS W T ER _ <br /> ❑SPECIAL WASTE . (4-- <br /> GENERATING <br /> GENERATING FACILITY 0 X 4 ,c) � <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER jRPC~B5E <br /> ADDRESS 0�, <br /> CITY, STATE,ZIP <br /> PHONE 1 END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE,�UT-IJONZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> c ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) _ <br /> Is true and accurate. - <br /> DISPOSE OTHER <br /> EMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMB DEBRIS <br /> Q NON-FRIABLE <br /> GNATUR RUED AGENT TE ASBESTOS <br /> f• U WOOD <br /> CP ASH <br /> PECIAL OTHER <br /> f'eDULING MUST BE MADE PRIOR TO 3.00 P M THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDUILED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY B FORE <br /> MANIFEST# 38187 <br /> " <br /> - GENCRATOR COPY <br />